Order Guide: PSA Testing

Prostate-Specific Antigen (PSA) is a blood test that looks for a protein that is produced in the prostate gland.  PSA levels are a marker of prostate size but can also be used to determine if someone has prostate cancer
What’s the difference between a screening PSA and a diagnostic PSA?
A screening PSA level is completed when a man has no prostate symptoms.  
A diagnostic PSA level is completed when a man has prostate symptoms.   
What are the symptoms of an enlarged prostate or prostate cancer?
Getting up at nighttime to urinate 
Straining to urinate
Starting and stopping when urinating
Having a slow or weak urinary stream 
Having an urgency to urinate
Having to urinate frequency
What is benign prosatic hyperplasia (BPH)?
BPH is the natural enlargement of the prostate that occurs in all men as they age.  Having an enlarged prostate doesn’t mean one has prostate cancer, but it can produce the same symptoms as prostate cancer.  
Should I get PSA screening? 
The Canadian Task for Preventative Health strongly recommends AGAINST screening for prostate cancer with a PSA test in men younger than 55 and older than 70.  
There is a benefit for men between 55 to 69 being screened, though the benefit is very small.  Approximately 1 in 1000 men screened will avoid prostate cancer death due to screening.
Are there downsides to getting a PSA test screened for?
There is a risk of false positives that can lead to unnecessary anxiety, repeat testing and unnecessary surgical procedures.  For example, a quoted statistic is that of 1000 men screened with a PSA level, 178 men will have a positive PSA test where there is no prostate cancer (i.e. they have an enlarged prostate).
4 of these 178 men will end up with complications from a biopsy including infection and/or bleeding resulting in hospitalization.
What are the risk factors for prostate cancer?
African American ancestry 
Having a father or brother with prostate cancer before age 65
Have a genetic risk factor, like the BRCA mutation in your family
When should you NOT use TeleTest for screening/testing?
Your symptoms are new and came on suddenly.
You have fevers or are unwell.
You cannot urinate.
You are incontinent (cannot control your bladder)
You have blood in your urine.
What is acute urinary retention?
Urinary retention is when the lower urinary tract becomes obstructed by an enlarged prostate, causing urine to back up in the urinary system.  This can cause permanent damage to the kidney and is life-threatening.  If you are unable to urinate or become incontinent of urine, we recommend an immediate visit to an urgent care centre.
When should I be referred to a specialist?
Canadian Urological Guidelines recommend referral in the following circumstances:
Recurrent or refractory urinary retention
Recurrent urinary tract infections (UTIs)
Bladder stones
Blood in your urine
Kidney damage determined by physician review of your eGFR (kidney function blood test)
You would like to see a specialist
Do I need a prostate exam?
We recommend a digital rectal exam annually if you have prostate symptoms, or sooner if there is a change in your symptoms.
What can I do to control my symptoms without medications?
Restrict fluid before bedtime
Avoid caffeinated beverages, alcohol and spicy foods
Bladder Training
Pelvic Floor Exercises
Ensure you are not constipated 
Avoid some medications (i.e. decongestants, antihistamines, diuretics, etc)


What is my prostate score?
The International Prostate Symptom Score (IPSS) - found here: https://qxmd.com/calculate/calculator_338/international-prostate-symptom-score-ipss is a validated tool used to assess the severity of your prostate symptoms.
Mild symptoms = IPSS < 7 
Bothersome moderate = IPSS 8-18
Severe = IPSS 19-35
References
[1] https://canadiantaskforce.ca/tools-resources/prostate-cancer-harms-and-benefits/​
[2] Nickel, J. C., Aaron, L., Barkin, J., Elterman, D., Nachabé, M., & Zorn, K. C. (2018). Canadian Urological Association guideline on male lower urinary tract symptoms/benign prostatic hyperplasia (MLUTS/BPH): 2018 update. Canadian Urological Association journal = Journal de l'Association des urologues du Canada, 12(10), 303–312. https://doi.org/10.5489/cuaj.5616
[3] https://www.healthlinkbc.ca/illnesses-conditions/cancer/prostate-cancer-screening

Order Guide - Anti-TPO Antibody

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What’s the difference between a screening PSA and a diagnostic PSA?

What are the symptoms of an enlarged prostate or prostate cancer?

What is benign prosatic hyperplasia (BPH)?

Should I get PSA screening?

Are there downsides to getting a PSA test screened for?

What are the risk factors for prostate cancer?

When should you NOT use TeleTest for screening/testing?

What is acute urinary retention?

When should I be referred to a specialist?

Do I need a prostate exam?

What can I do to control my symptoms without medications?

References